Clinical Impact of Asymptomatic Presentation Status in Patients With Paroxysmal and Sustained Atrial Fibrillation

Esato, Masahiro; Yuan, Chun; An, Yoshimori; Ogawa, Hisashi; Wada, Hiromichi; Hasegawa, Koji; Tsuji, Hikari; Abe, Mitsuru; Lip, Gregory Y.H.; Akao, Masaharu

doi:10.1016/j.chest.2017.08.004

Cited by 34 publications

(37 citation statements)

References 22 publications

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“…5,13 Therefore, assuming that silent paroxysmal AF is generally associated with frequent AF episodes, once again, the "transitional form" theory is likely. The present study and a previous one 2, 3 showed an association of silent paroxysmal AF with a previous stroke. The most likely interpretation is that asymptomatic patients with a previous stroke were more Note: The values are the mean ± SD, the n (%).…”

Section: Silent Paroxysmal Af's Higher Likelihood Of Atrial Arrhythsupporting

confidence: 83%

“…Recent clinical trials have suggested silent paroxysmal AF as a possible cause of cryptogenic strokes . Moreover, higher mortality in patients with silent vs symptomatic paroxysmal AF has recently been reported . There is thus an urgent need for a comprehensive approach for early diagnosis of silent paroxysmal AF.…”

Section: Introductionmentioning

confidence: 99%

“…There is thus an urgent need for a comprehensive approach for early diagnosis of silent paroxysmal AF. To date, only the epidemiological characteristics of silent paroxysmal AF are known; elderly, male sex, a previous stroke, etc . and they never answer an essential question, “why are some patients with paroxysmal AF asymptomatic?”.…”

Section: Introductionmentioning

confidence: 99%

“…1 Moreover, higher mortality in patients with silent vs symptomatic paroxysmal AF has recently been reported. 2,3 There is thus an urgent need for a comprehensive approach for early diagnosis of silent paroxysmal AF. To date, only the epidemiological characteristics of silent paroxysmal AF are known; elderly, male sex, a previous stroke, etc.…”

Section: Introductionmentioning

confidence: 99%

“…To date, only the epidemiological characteristics of silent paroxysmal AF are known; elderly, male sex, a previous stroke, etc. 2,3 and they never answer an essential question, "why are some patients with paroxysmal AF asymptomatic?". We in the present study aimed to answer the question with the use of an extensive cardiac electrophysiological approach.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac electrophysiological characteristics of silent paroxysmal atrial fibrillation: What causes asymptomaticity?

Hironobe

Sairaku

Nakano

et al. 2019

Cardiovasc electrophysiol

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Background A diagnosis of silent paroxysmal atrial fibrillation (AF) is highly challenging due to its asymptomatic and intermittent nature. The goal of the present study was to clarify its asymptomaticity with the use of a comprehensive electrophysiological approach. Methods We prospectively compared (a) 24‐hour Holter monitoring data, (b) invasive cardiac electrophysiological properties, (c) AF inducibility, and (d) outcome of radiofrequency catheter ablation between patients with symptomatic paroxysmal AF and those with silent paroxysmal AF, defined as transient asymptomatic AF detected by chance. Results Patients with silent paroxysmal AF (N = 57) were more likely than patients with symptomatic paroxysmal AF (N = 282) to be male (75.4% vs 56.7%; P = .009), and to have a previous stroke (17.5% vs 6.7%; P = .008), more prolonged atrio‐His interval (114.9 ± 29.1 vs 105.5 ± 24.1 ms; P = .01), longer atrioventricular nodal effective refractory period (352.3 ± 103 vs 318.2 ± 77.2 ms; P = .007), slower Wenckebach cycle length (488.5 ± 83.9 vs 443.3 ± 74.9 ms; P < .001), and lower maximum heart rate during AF (128.7 ± 31.9 vs 143.9 ± 29.6 beats/min; P = .02). Atrial ectopy (median [interquartile range], 385 [88, 2430] vs 207 [73.8, 870.8] beats/24 h; P = .02) and pharmacological AF induction (66.7% vs 43.2%; P = .02) were more common in silent paroxysmal AF patients. There was no difference in the 1‐year freedom from AF following the ablation between the two patient groups. Conclusions The more attenuated atrioventricular conduction properties in silent paroxysmal AF patients may explain their asymptomatic nature, and their higher likelihood of atrial arrhythmias may increase the chance to detect AF episodes. Whether or not they benefit from catheter ablation is uncertain.

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Section: Silent Paroxysmal Af's Higher Likelihood Of Atrial Arrhythsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cardiac electrophysiological characteristics of silent paroxysmal atrial fibrillation: What causes asymptomaticity?

Hironobe

Sairaku

Nakano

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

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Implantable cardiac monitors compared with conventional methods for the detection of atrial high-rate episodes in individuals with embolic stroke of undetermined source

Koo

Inglis

Freedman

et al. 2019

Cochrane Database of Systematic Reviews

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Importance of non‐cardiovascular comorbidities in atrial fibrillation and heart failure with preserved ejection fraction

Hamatani,

Iguchi,

Kato

et al. 2024

ESC Heart Failure

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AimsAtrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) are interlinked and frequently coexisting conditions. To date, patients with AF and HFpEF have limited evidence guiding their management. This study aimed to investigate the predictors of adverse outcomes among patients with AF and HFpEF.MethodsThe Fushimi AF Registry is a community‐based prospective survey of AF patients in Fushimi‐ku, Kyoto, Japan. From the registry, we explored predictors for a composite of cardiac death or HF hospitalization among AF patients with HFpEF (defined as having a prior HF hospitalization or New York Heart Association class ≥2 in association with heart disease and left ventricular ejection fraction ≥50%). Besides, we investigated whether the scoring using the predictors identified by the Fushimi AF Registry could stratify the outcomes in patients with AF and HFpEF registered in another independent Kyoto Congestive Heart Failure Registry.ResultsOf 755 patients with AF and HFpEF [mean age: 77.5 ± 9.9 years; female: 391 (52%); paroxysmal AF: 258 (34%); and mean CHA2DS2‐VASc score: 4.5 ± 1.5], cardiac death or HF hospitalization occurred in 246 patients (33%) during the median follow‐up period of 4.4 years in the Fushimi AF Registry. Using multivariate Cox regression analysis, age ≥75 years [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.26–2.36] and non‐cardiovascular comorbidities such as anaemia (HR: 1.83, 95% CI: 1.37–2.46), chronic kidney disease (HR: 1.69, 95% CI: 1.27–2.26), diabetes mellitus (HR: 1.55, 95% CI: 1.15–2.09) and chronic obstructive pulmonary disease (HR: 1.87, 95% CI: 1.08–3.22) were independent predictors of adverse outcomes. Meanwhile, cardiovascular comorbidities including coronary artery disease, valvular heart disease or cardiomyopathy were not significantly associated with adverse outcomes. These results were also the case when analysed for patients with AF and HFpEF who registered in the Kyoto Congestive Heart Failure registry (N = 878). The score assigning 1 point for each five predictors (age, anaemia, chronic kidney disease, diabetes mellitus and chronic obstructive pulmonary disease; ranging 0–5 points) stratified the incidence of adverse outcomes among patients with AF and HFpEF registered in the Kyoto Congestive Heart Failure Registry as well as among those in the Fushimi AF Registry (both log‐rank; P < 0.001).ConclusionsNon‐cardiovascular comorbidities such as anaemia, diabetes mellitus and kidney or pulmonary disease in addition to advanced age were independent predictors of adverse outcomes in patients with AF and HFpEF. Our study suggests the importance of focusing on these non‐cardiovascular comorbidities for individualized risk stratification and optimal management in patients with AF and HFpEF.

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Clinical Impact of Asymptomatic Presentation Status in Patients With Paroxysmal and Sustained Atrial Fibrillation

Abstract: UMIN Clinical Trials Registry; No.: UMIN000005834; URL: www.umin.ac.jp/ctr/index.htm.

Cited by 34 publications

References 22 publications

Cardiac electrophysiological characteristics of silent paroxysmal atrial fibrillation: What causes asymptomaticity?

Cardiac electrophysiological characteristics of silent paroxysmal atrial fibrillation: What causes asymptomaticity?

Implantable cardiac monitors compared with conventional methods for the detection of atrial high-rate episodes in individuals with embolic stroke of undetermined source

Importance of non‐cardiovascular comorbidities in atrial fibrillation and heart failure with preserved ejection fraction

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